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File Number: (For OSE Use Only) NEW MEXICO OFFICE OF THE STATE ENGINEER APPLICATION FOR PERMIT TO CHANGE LOCATION OF WELL 1. WATER RIGHT OWNER Name: Zeno Mach Contact: Address: Mai Gadon 49 biro Rath Work Phone: Home Phone: City: sun* State: ,a Zip: 117016 2. PURPOSE OF USE Domestic: x Livestock: x Irrigation: x Municipal: Industrial: Commercial: Other (specify): minchess Specific use: 3. QUANTITY Consumptive Use: to acre-feet per annum Diversion Amount: w acre-feet per annum 4. PLACE OF USE 24 acres of land described as follows: Subdivision of Section Section Township Range Acres (District or (Map No.) (Tract No.) Hydrographic Survey) SW W. SW 1/4. NE 1/4 SE IN Is 12N SE 22 12N SE Who is the owner of the land? annwesTmom 20 Do Not Write Below This Line File Number: Trn Number: Form: wr-06 page 1 of 4 EFTA01222821 File Number: (For OSE Use Only) NEW MEXICO OFFICE OF THE STATE ENGINEER APPLICATION FOR PERMIT TO CHANGE LOCATION OF WELL 5. CHANGE FROM A. LOCATION OF WELL (Location a, b, c, d required, e or f if known) W 1/4 1/4 a. W N/W M E 1/4 Section: 23 Township: 12 Range: 9 N.M.P.M. in Sento F• County. b. X = feet, Y - feet, N.M. Coordinate System Zone in the Grant. U.S.G.S. Quad Map c. Latitude: d m s Longitude: d m s d. East {m), North (m), UTM Zone 13, NAD (27 or 83) e. Tract No. , Map No. of the Hydrographic Survey f. Lot No. , Block No. of Unit/Tract Subdivision recorded in g. Other: of the County. h. Give State Engineer File Number of existing well: E-7871S i. On land owned by (required): Jeffrey Epstein, Truste j. Is well to be plugged or capped? If not, state for what use retained: mums Do Not Write Below This Line File Number: Trn Number: Form: wr-06 page 2 of 4 EFTA01222822 File Number: (For OSE Use Only) NEW MEXICO OFFICE OF THE STATE ENGINEER APPLICATION FOR PERMIT TO CHANGE LOCATION OF WELL 6. CHANGE TO A. LOCATION OF WELL (Location a, b, c, d required, e or f if known) a. NE 1/4 sE 1/4 se 1/4 Section:n Township: n Range :e N .M. P . M. in s County. ager. b. X = feet, Y - Zone in the Grant. U.S.G.S. Quad Map c. Latitude: m dm mu s Longitude: ms $ du m n d. East (m), North (m), UTM Zone 13, NAD (27 or 83) e. Tract No. , Map No. of the Hydrographic Survey feet, N.M. Coordinate System f. Lot No. , Block No. of Unit/Tract of the Subdivision recorded in County. g. Other: h. Give State Engineer File Number of existing well: inns i. On land owned by (required): j. If new well, give approximate depth(if known) feet; Outside diameter of casing inches. Name of driller and license number (if known) 7. REASON FOR CHANCE Application is made to change location of well for the following reasons: To mania" Wag WNW *SW 6) aiming kiradnidurs. 8. ADDITIONAL STATEMENTS OR EXPLANATIONS: Do Not Write Below This Line File Number: Trn Number: Form: wr-06 page 3 of 4 EFTA01222823 File Number: (For OSE Use Only) NEW MEXICO OFFICE OF THE STATE ENGINEER APPLICATION FOR PERMIT TO CHANGE LOCATION OF WELL ACKNOWLEDGEMENT (I, We)ateµeaam affirm that the (Please Print) foregoing statements are true to the best of (my, our) knowledge and belief. Applicant Signature Applicant Signature ACTION OF STATE ENGINEER This application is approved/denied/partially approved provided it is not exercised to the detriment of any others having existing rights, and is not contrary to the conservation of water in New Mexico nor detrimental to the public welfare; and further subject to the following conditions: Witness my hand and seal this day of , 20 , State Engineer By: Do Not Write Below This Line File Number: Trn Number: Form: wr-06 page 4 of 4 EFTA01222824